Goal striving and maladaptive coping in adults living with spinal cord injury: associations with affective well-being

Re-evaluation of the relationship between paranormal belief and perceived stress using statistical modelling

Recent research indicates that paranormal belief, in the absence of allied cognitive-perceptual and psychopathology-related factors, is not associated with negative wellbeing outcomes. However, investigators have historically reported relationships between specific facets of belief (e.g., superstition) and stress vulnerability. These typically derive from the Revised Paranormal Belief Scale (RPBS), which has questionable psychometric integrity. The main issue being that several RPBS items perform poorly. Noting this, the present paper re-examined the relationship between paranormal belief and stress using the Rasch purified version of the RPBS. This comprises two dimensions, called Traditional Paranormal Belief (TPB) and New Age Philosophy (NAP). These are operationalised in terms of function. Specifically, whether belief provides a sense of control at the social (TPB) or individual level (NAP). Accordingly, this study examined whether TPB and NAP were differentially predictive of levels of perceived stress. In this context, stress served as an indicator of well-being. A sample of 3084 participants (Mage = 50.31, SD = 15.20, range 18-91) completed the RPBS alongside the 10-item Perceived Stress Scale (PSS-10). Confirmatory factor analysis and structural equation modelling revealed that TPB was significantly predictive of higher Distress, and lower Coping. NAP was neither predictive of Distress nor Coping. These findings support the notion that TPB is attendant with external control, particularly the notion that unknown supernatural forces/powers influence existence.

Illness Denial in Medical Disorders: A Systematic Review

INTRODUCTION

Illness denial pertains to medical patients who do not acknowledge the presence or severity of their disease or the need of treatment.

OBJECTIVE

This systematic review was performed to clarify the clinical role and manifestations of illness denial, its impact on health attitudes and behavior, as well as on short- and long-term outcomes in patients with medical disorders.

METHODS

The systematic search according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was conducted on PubMed, Scopus, and Web of Science.

RESULTS

The initial search yielded a total of 14,098 articles; 176 studies met the criteria for inclusion. Illness denial appeared to be a relatively common condition affecting a wide spectrum of health attitudes and behavior. In some cases, it may help a person cope with various stages of illness and treatment. In other situations, it may determine delay in seeking treatment, impaired adherence, and reduced self-management, leading to adverse outcomes. The Diagnostic Criteria for Psychosomatic Research (DCPR) were found to set a useful severity threshold for the condition. An important clinical distinction can also be made based on the DCPR for illness denial, which require the assessment of whether the patient has been provided with an adequate appraisal of the medical situation.

CONCLUSIONS

This systematic review indicates that patients with medical disorders experience and express illness denial in many forms and with varying degrees of severity. The findings suggest the need for a multidimensional assessment and provide challenging insights into the management of medical disorders.

Paranormal belief, cognitive-perceptual factors, and well-being: A network analysis

By assessing interrelationships among variables within a specified theoretical framework, network analysis (NA) provides nuanced insights into how associations between psychological constructs are related to outcome measures. Noting this, the authors used NA to examine connections between Paranormal Belief, cognitive-perceptual factors (Schizotypy, Transliminality, and Manic-Depressive Experience), and well-being (Life Satisfaction, Meaning in Life, Somatic Complaints, Perceived Stress, Depressive Symptoms). Data derived from a sample of 3,090 participants (mean age = 50.30, standard deviation = 15.20; 46.5% male, 53.1% female) who completed standardised self-report measures capturing the study constructs online. Transliminality, Unusual Experiences (positive schizotypy), and Depressive Experience demonstrated high expected influence centrality. This indicated that these factors were the most strongly connected and influential in the network. Moreover, Transliminality was a connecting variable between Paranormal Belief, positive schizotypy, and psychopathology. Depressive Experience bridged the relationship between Transliminality and well-being. The conceptual implications of these outcomes are discussed with regards to better understanding relationships between Paranormal Belief, cognitive-perceptual factors, and well-being.

Paranormal belief and well-being: The moderating roles of transliminality and psychopathology-related facets

Evaluation of prior research suggests that belief in the paranormal is more likely to be associated with negative psychological functioning, when presented alongside cognitive-perceptual factors that askew thinking and insight. The current study examined this notion using a sample of 3,084 participants (1,382 males, 1,693 females, nine non-binary). Respondents completed self-report measures assessing Paranormal Belief, Transliminality, psychopathology-related characteristics (Schizotypy and Manic-Depressive Experience), and well-being (Perceived Stress and Somatic Complaints). Responses were analysed via correlations and moderation. Paranormal Belief correlated positively with Transliminality, psychopathology-related measures, Perceived Stress, and Somatic Complaints. Moderation analyses revealed that Transliminality and psychopathology-related variables (i.e., the Unusual Experiences and Cognitive Disorganisation subscales of schizotypy, and Manic-Depressive Experience) interacted with Paranormal Belief in complex ways and were allied to higher scores on negative well-being outcomes. This indicated that within paranormal believers, Transliminality and specific psychopathology-related variables in combination predicted susceptibility to negative well-being outcomes.

From bad to worse: Avoidance coping with stress increases conspiracy beliefs

The present research empirically examines how different types of coping strategies are associated with belief in conspiracy theories. Conspiracy beliefs have been linked to the frustration of basic needs and seem to increase during major world events that evoke stress. Thus, we hypothesized that they may serve as a psychological response to maladaptive coping strategies. This hypothesis was tested among British participants and conceptually replicated across three studies. Cross-sectionally, we examined coping strategies (i.e., self-sufficient, social-support, avoidance, and religious) and belief in a specific conspiracy theory (Study 1, n = 199) and belief in general notions of conspiracy (Study 2, n = 411). In Study 3 (n = 398), we experimentally primed different coping styles via a mnemonic recollection procedure and measured belief in notions of conspiracy. Avoidance coping (recognized as being maladaptive and leading to at least temporary disengagement and abandonment of goal-related behaviours) positively predicted belief in conspiracy theories (Studies 1 and 2). In Study 3, priming avoidance coping (vs. self-sufficient coping or no coping strategy) significantly increased belief in conspiracy theories. These findings suggest that using maladaptive coping strategies (either dispositional or situationally induced) may foster conspiracy beliefs.

Predictors of Self-Efficacy Among People With Spinal Cord Injury During Inpatient Rehabilitation: A Cross-Sectional Study

PURPOSE

This study aimed to investigate the predictors of self-efficacy among Chinese people with spinal cord injury (SCI).

DESIGN

A cross-sectional, descriptive, correlational design was adopted.

METHODS

121 participants were recruited from two rehabilitation hospitals in Shaanxi, China, from August 2016 to June 2017. The Moorong Self-Efficacy Scale was used to assess participants' self-efficacy levels. Participants' sociodemographic or clinical characteristics, functional independence, coping ability (measured using the Brief Coping Orientations to Problems Experienced Inventory), and social support (measured using the Six-item Social Support Questionnaire) were assessed as potential predictors of self-efficacy. A multiple linear regression model was conducted to identify the factors predicting self-efficacy score.

RESULTS

The mean age of the participants was 41 (SD 11.9) years and 90% were male. Participants' mean self-efficacy score was 53.9 (SD 15.7). Multiple linear regression results indicated that injury type (i.e., paraplegia or tetraplegia; β = 0.290, p < .001) and adaptive coping (β = 0.561, p < .001) were significant predictors, accounting for 62% of the variance in self-efficacy scores.

CONCLUSIONS

Our findings imply that psychosocial interventions that target enhancing various adaptive coping strategies could have positive effects on self-efficacy in people with SCI.

CLINICAL RELEVANCE

Injury type and adaptive coping ability are two key factors related to patients' self-efficacy post-SCI. Psychosocial interventions that target enhancing various adaptive coping strategies could have positive effects on self-efficacy in people with SCI.

A Home-Based Telerehabilitation Program for Patients With Stroke

BACKGROUND

Although rehabilitation therapy is commonly provided after stroke, many patients do not derive maximal benefit because of access, cost, and compliance. A telerehabilitation-based program may overcome these barriers. We designed, then evaluated a home-based telerehabilitation system in patients with chronic hemiparetic stroke.

METHODS

Patients were 3 to 24 months poststroke with stable arm motor deficits. Each received 28 days of telerehabilitation using a system delivered to their home. Each day consisted of 1 structured hour focused on individualized exercises and games, stroke education, and an hour of free play.

RESULTS

Enrollees (n = 12) had baseline Fugl-Meyer (FM) scores of 39 ± 12 (mean ± SD). Compliance was excellent: participants engaged in therapy on 329/336 (97.9%) assigned days. Arm repetitions across the 28 days averaged 24,607 ± 9934 per participant. Arm motor status showed significant gains (FM change 4.8 ± 3.8 points, P = .0015), with half of the participants exceeding the minimal clinically important difference. Although scores on tests of computer literacy declined with age ( r = -0.92; P < .0001), neither the motor gains nor the amount of system use varied with computer literacy. Daily stroke education via the telerehabilitation system was associated with a 39% increase in stroke prevention knowledge ( P = .0007). Depression scores obtained in person correlated with scores obtained via the telerehabilitation system 16 days later ( r = 0.88; P = .0001). In-person blood pressure values closely matched those obtained via this system ( r = 0.99; P < .0001).

CONCLUSIONS

This home-based system was effective in providing telerehabilitation, education, and secondary stroke prevention to participants. Use of a computer-based interface offers many opportunities to monitor and improve the health of patients after stroke.

Denial Defense Mechanism in Dialyzed Patients

BACKGROUND

It is a struggle to identify the most adaptive coping strategies with disease-mediated stress. Here, we hypothesize that intensity of coping strategies, including denial, in patients with end-stage renal disease (ESRD), varies with type of renal replacement therapy (RRT).

MATERIAL AND METHODS

We enrolled 60 in-center hemodialyzed patients (HD) and 55 patients treated with continuous ambulatory peritoneal dialysis (CAPD). We administered the Coping Inventory with Stressful Situation, Profile of Mood States, and Stroop Anxiety Inventory to measure patient coping strategies in the context of their ESRD. Denial defense mechanism was measured via the IBS-R/ED. The Nottingham Health Profile was used to evaluate self-perceived quality of life. Serum potassium, urea, creatinine, phosphorus, calcium, albumin, and hematocrit were utilized as the measurements of adequacy of dialysis.

RESULTS

HD patients had higher self-reported intensity of denial mechanism and avoidance-oriented strategies versus CAPD patients. Because a single strategy is almost never employed, we conducted cluster analysis. We identify 3 patterns of coping strategies using cluster analysis. "Repressors" employed denial and avoidance strategies and were predominant in HD. The second cluster consists of subjects employing predominantly task-oriented strategies with equal distribution among dialyzed patients. The third cluster encompassed a small group of patients who shared higher intensity of both denial and task-oriented strategies. Health-related outcome, anxiety, and mood profile were similar across all patients.

CONCLUSIONS

HD patients predominantly used "repressive" strategies. Patients on RRT utilized denial and avoidance-based strategies to achieve satisfactory outcome in terms of perceived quality of life. We conclude that these coping mechanisms that were previously thought to be inferior are beneficial to patient compliance with RRT.

The Situational Version of the Brief COPE: Dimensionality and Relationships With Goal-Related Variables

This study is aimed at investigating the dimensionality of the situational version of the Brief COPE, a questionnaire that is frequently used to assess a broad range of coping responses to specific difficulties, by comparing five different factor models highlighted in previous studies. It also aimed at exploring the relationships among coping responses, personal goal commitment and progress. The study involved 606 adults (male = 289) ranging in age from 19 to 71. Using confirmatory factor analysis, we compared five models and assessed relationships of coping responses with goal commitment and progress. The results confirmed the theoretical factor structure of the situational Brief COPE. All the 14 dimensions showed acceptable reliability and relationships with goal commitment and progress, attesting the reliability and usefulness of this measure to evaluate coping responses to specific events.

Motivation-focused thinking: Buffering against stress-related physical symptoms and depressive symptomology

Developmental transitions are experienced throughout the life course and necessitate adapting to consequential and unpredictable changes that can undermine health. Our six-month study (n = 239) explored whether selective secondary control striving (motivation-focused thinking) protects against the elevated levels of stress and depressive symptoms increasingly common to young adults navigating the challenging school-to-university transition. Path analyses supplemented with tests of moderated mediation revealed that, for young adults who face challenging obstacles to goal attainment, selective secondary control indirectly reduced long-term stress-related physical and depressive symptoms through selective primary control and previously unexamined measures of discrete emotions. Results advance the existing literature by demonstrating that (a) selective secondary control has health benefits for vulnerable young adults and (b) these benefits are largely a consequence of the process variables proposed in Heckhausen et al.'s (2010) theory.

Career Goals in Young Adults

We tested a model based on the dual-process framework that assessed the relationships among personal resources, career goal appraisals, career attitudes, and career goal management, which have not been previously assessed together. The model (tested on a sample of 486 young adults: 74% female, Mage = 22 years) proposed that personal resources (assimilation and accommodation) were associated with career goal management strategies (goal engagement and disengagement) and that these relationships were mediated by career goal appraisals (perceived attainability, importance, and substitutability) and career attitudes (career optimism and locus of control). Career optimism mediated between assimilation and goal engagement, and importance mediated between accommodation and goal disengagement. The results contribute to a better understanding of goal management processes in the career domain and have implications for the application of the dual-process framework to career development in young adulthood.

Psychological coping with intermittent self-catheterisation (ISC) in people with spinal injury: a qualitative study

BACKGROUND

Management of bladder function is important in rehabilitation of spinal injury. Failure to comply with bladder management techniques, such as intermittent catheterisation, can have long-term consequences leading to renal failure. It is important, therefore, that spinal injured people adapt to the therapy at an early stage, but there is little research aimed at exploring patient experiences of ISC.

OBJECTIVES

This study explores the experiences of patients who have a spinal cord injury and who carry out ISC in order to identify psychological coping factors that might affect therapy adherence.

DESIGN

A qualitative study using a Grounded Theory framework involving individual interviews.

SETTING AND PARTICIPANTS

There were 15 participants (11 men and 4 women), median age 52 years (range 24-68) who were discharged from spinal rehabilitation, living in the community and using ISC. The sample was recruited from the patient lists of a tertiary spinal injury unit and a Specialist Continence Service.

METHODS

In-depth interviews were carried out in participants' own homes by a trained interviewer. Interviews were audio-recorded, transcribed and analysis carried out using NUD*IST6 software.

RESULTS

A core category of 'normalisation' was identified and the causes and consequences related to this category are reported. Categories of 'independence' and 'control' were closely related to, and were interdependent with, 'normalisation'. Participants were relieved of worry when they could exert control over their bladder function, and a feeling of normalisation helped them to maintain the integrity of their self-image. The ultimate outcome was either adaptation or maladaptation. Adaptation was dependent on positive acceptance of intermittent catheterisation and the need for good bladder management at the outset, whereas maladaptation was a result of avoidance and denial.

CONCLUSIONS

Adherence to ISC is related to early psychological coping strategies of active acceptance rather than denial and avoidance in relation to bladder management. It is important to support positive appraisals of ISC, particularly from the patient perspective, which suggest that it is the first step to independence and that it also provides normalisation and control of bladder function. ISC can contribute to a good quality of life, dignity, privacy and self-esteem.